Vermont

Beginning in the 2005-2006 Vermont Legislative Session, health care reform in the State of Vermont was launched through the Blueprint for Health (Blueprint). In 2007, with the participation of Vermont’s three largest commercial payers and Medicaid, the legislature authorized pilots to test an Integrated Health Services Model (the Bluprint model). The Blueprint model includes advanced primary care in the form of Patient Centered Medical Homes (PCMHs), multi-disciplinary support services through Community Health Teams (CHTs) which support PCMHs, multi-insurer payment reforms that fund PCMH transformation community health teams, and activities focused on continuous improvement using comparative valuation (Learning Health System). 

In 2011, Medicare selected Vermont as a participant in its Multi-Payer Advanced Primary Care Practice Demonstration initiative, and agreed to participate in the Blueprint project. The project now includes 79 practice sites serving approximately 360,000 patients, more than half of the state’s population. In 2013, the Blueprint was expanded statewide.

During the last few years, this work continued with enactment of  Act 48 (2011) and passage of Act 171 (H.559), signed by Governor Peter Shumlin on May 16, 2012.  They put Vermont on a path toward an integrated health care delivery system with a budget regulated by the new Green Mountain Care Board, universally available health insurance coverage that is not linked to employment and a single system for administration of claims and payments to providers. 

In addition, Vermont's Request For Proposals for QHPs encourages issuers to include innovative preventive care models in its non-standardized plan designs such as Advanced Primary Care Practices, PCMHs and Community Health Teams. 

Primary Care Innovations and PCMH Activity

Dual Eligible 2703 SPA CPC CPC+ PCMH QHP PCMH Legislation Private Payer

Multi-Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Vermont Blueprint for Health Multi-Payer Statewide Multi-Payer Advanced Primary Care Practice (MAPCP)

Private Payer Programs

State Legislation

Legislation Status Year
Vermont Act 48 (VT LEG 270379.1)

The Act put Vermont on a path toward an integrated health care delivery system with a budget regulated by the new Green Mountain Care Board, universally available health insurance coverage that is not linked to employment and a single system for administration of claims and payments to providers.

Active 2011
Senate Bill 53, House Bill 89

This bill proposes to require the Green Mountain Care Board to determine the proportion of health care spending currently allocated to primary care, recommend the proportion that should be allocated to primary care going forward, and project the avoided costs that would likely result if that proportion were achieved.  

It would then direct certain payers to provide a plan for achieving the allocation of primary care recommended for them by the Board.

The House and Senate bills differ slightly, with the House bill specifying that primary care be allocated 12 percent or more of spending by 2025.

Active 2019
Act 171 (H.559)

The act expresses legislative intent that access to and payments for community health teams should begin at least six months before a medical practice is scheduled to be scored for Blueprint recognition, that the Blueprint director increase payments to medical homes because of new qualification requirements, and that all health plans, including the multistate plans required under the ACA, should participate in the Blueprint for Health.

Active 2012

State Facts:

Population:
620,000
Uninsured Population:
8%
Total Medicaid Spending FY 2013: 
$1.5 Billion 
Overweight/Obese Adults:
61.9%
Poor Mental Health among Adults: 
34.8%
Medicaid Expansion: 
Yes

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